Suspicions are growing about the medical evidence used to justify the release of the man convicted of the Lockerbie bombing. Investigation by Paul Hutcheon and Tom Gordon

JUSTICE secretary Kenny MacAskill is under further pressure over his decision to free the Lockerbie bomber after cancer experts questioned whether Abdelbaset Ali Mohmed al Megrahi has less than three months to live. Megrahi, released from prison by the SNP government on compassionate grounds, told the Sunday Herald that he was about to undergo a course of chemotherapy, which could prolong his life even longer.

The three-month prognosis is now under greater scrutiny after two of the UK's most senior prostate specialists said the Libyan could live for another year. David Neal, professor of surgical oncology at Addenbrooke's Hospital, Cambridge, said: "For somebody with just generally hormonally-lapsed prostate cancer with metastases, the time-scales are usually 12 to 18 months."

Professor Roger Kirby - chairman of the charity Prostate UK, founder of the Urology Foundation and director of The Prostate Centre - said MacAskill could have "egg on his face" after accepting that Megrahi's terminal cancer left him just three months to live.

The comments pile pressure on MacAskill to justify his decision ahead of Wednesday's parliamentary debate on the release of the only man ever convicted of killing 270 people in the bombing of Pan Am Flight 103 over Lockerbie in 1988.

MacAskill released Megrahi after a report by the Scottish Prison Service's director of health and care, Andrew Fraser. However, it emerged that none of the four consultants who examined Megrahi were willing to say whether or not he had three months to live, with only a GP suggesting three months was a "reasonable estimate" of life expectancy.

Instead, Dr Fraser noted: "Whether or not prognosis is more or less than three months, no specialist would be willing to say." Fraser then distilled the opinions of the four specialists and the GP into a report to MacAskill that recommended Megrahi's release.

However, Fraser is an expert in public health and drug addiction, not cancer. In September 2004, Fraser told MSPs on the Scottish Parliament's Justice 1 committee that addressing addiction was "my field".

He explained: "My end of the business is dealing with the maintenance and stabilisation interventions that try to get people off drugs and stop them abusing alcohol."

The three months figure is crucial to MacAskill's argument as Scottish Prison Service guidance states that compassionate release "may be considered where a prisoner is suffering from a terminal illness and death is likely to occur soon. There are no fixed time limits but life expectancy of less than three months may be considered an appropriate period."

The decision has been savaged by opposition politicians who believe MacAskill has bungled Megrahi's release. The justice secretary is now under more pressure after it emerged that Megrahi, 57, is about to undergo chemotherapy, which could prolong his life even longer.

Megrahi's prostate cancer, which was diagnosed in September 2008, has since spread elsewhere in his body and has been resistant to hormone treatment since July.

THE Libyan told Sunday Herald and Herald writer Lucy Adams in Tripoli last week: "There will be doctors coming from abroad to discuss different treatments. We have had recommendations from consultants about the treatment I am receiving and I think they would like to change it. They are not happy with the treatment.

"I am expecting they will start chemotherapy but the side effects are very bad. I have got to get another MRI scan and bone scan. It was a difficult decision but it was also that I had had a blood test and had a very bad indication in my type of case. It was the indication that I would have to start chemotherapy as soon as possible."

Two of the UK's most senior prostate cancer experts are openly questioning the three-month assumption behind MacAskill's decision. Professor Neal said: "If you take the average statistics of men with metastatic prostate that is resistant to hormonal ablation, you are looking at a life expectancy of about a year to 18 months.

"The main advantage of chemotherapy is that it improves the symptoms. If Mr Al-Megrahi has bone pain, he would get significant benefit from the Docetaxel chemotherapy drug treatment.

"It would extend his life expectancy, but it is not curative. If he has metastatic prostate cancer, there is evidence that chemotherapy can improve survival by around a month or six weeks, and improve the symptoms he has. It's very, very difficult to be as precise as three months."

Professor Kirby also has his doubts about the three-month time period. "I would say the GP is the least qualified of the five doctors to give that opinion, unless he's got a crystal ball," he said.

"Megrahi could easily live a lot longer than three months, and there are some new treatments coming on line which can extend life quite significantly in patients like this.

"So you could easily find he could get back to Libya and they could give him all of these new drugs, and he could be alive six months, nine months, 12 months later.

"Kenny MacAskill could have even more egg on his face if this guy happens to be alive six months or longer from now, and if the Libyan government make a big song and dance about it, he'll look even more foolish."

Richard Simpson, a Labour MSP who is also a cancer expert, said: "Roger Kirby is the top specialist in the UK on this topic. My central point is that MacAskill failed in his duty to obtain a second opinion from a cancer expert, or a palliative care doctor. To base it on one opinion was wrong."

However, another leading prostate cancer expert who provided an independent medical assessment of Megrahi in June said the convicted bomber did not have long left.

Professor Karol Sikora, medical director of care group CancerPartners UK, said: "Mr Al Megrahi has a very aggressive form of prostate cancer that has spread widely. Although he initially responded to treatment, this is now no longer working.

"We believe he has only a very short period of time to live. We believed an urgent decision on his future was needed as further medical deterioration is likely to take place very soon."

Professor Sikora said that chemotherapy would only adds weeks to Megrahi's life, but admitted that the case was about more than medicine: "The politicians wanted a definitive statement on when he was going to die. That's not really possible."

Scottish Conservative leader Annabel Goldie said: "The SNP claimed that medical experts recommended the release, but they have only published a report from the medical officer which says no expert would give a prognosis of three months.

"We have called from day one for any decision to be based on credible, independent advice.

"Alex Salmond's government has so far produced none. If they don't produce it, then public anger and outrage will only grow."

Megrahi is expected to meet his Scots lawyer, Tony Kelly, in Tripoli this week, to discuss the release of hitherto secret court documents. The Libyan abandoned his appeal almost a fortnight ago, in the belief it would expedite his release from Greenock prison on compassionate grounds.

Although it had no legal bearing on compassionate release, the move fuelled suspicions that Megrahi's release two days later was part of a deal to drop a case that could have exposed flaws in his trial at Camp Zeist, and embarrassed the Scottish legal system.

Megrahi, who is writing a book, has indicated he wants some of the thousands of pages prepared for the appeal to be released, in order to establish his innocence.

The Scottish Criminal Cases Review Commission's secret report on the Megrahi case ran to 800 pages, with 13 volumes of appendices.

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Treatments which could keep Megrahi alive for months

By Professor Roger Kirby Chairman, Prostate UK

The decision to release the Lockerbie bomber and allow his return to Libya was based on the fact that he is suffering from terminal prostate cancer, and apparently has only three months left to live.

"Apparently" is the crucial word here because I am extremely sceptical that Megrahi's demise will occur on cue.

Even without knowledge of his exact medical details, I would predict that he may live considerably longer than the twelve weeks that are supposedly left to 12 and which underpinned the argument for his compassionate release.

These days, state-of-the-art treatment strategies are prolonging the lives of men who would previously have been considered beyond medical help. And in my experience, patients with advanced prostate cancer - even when it has spread to the skeleton - are capable of surviving for many months, and sometimes even years, more than their doctors expect.

Megrahi's doctors at home are reportedly not happy with the treatment he received in Scotland.

He is said to have been "re-staged" (assessed with an MRI and bone scan) and to be continuing chemotherapy treatment - probably with taxotere, a compound which has been proven in clinical trials to improve survival.

However, there are several new drugs in development, some of which may be available to him and which have the potential to extend the life of the only person ever to be convicted of the Lockerbie bombing.

Abiraterone, developed by scientists at the Royal Marsden Hospital, has been found to have almost miraculous effects on men with prostate cancer that has spread and become resistant to the first-line hormonal treatment.

Manipulating the hormonal therapy, for example by adding to it an oestrogen such as stilboestrol, can also stave off the inevitable for quite prolonged periods.

Newer compounds, such as AstraZeneca's ZD 4054, which target the mechanisms within the cell that allow prostate cancer cells to grow and divide, have also been found to produce exciting results.

Another treatment that could potentially be used in Al-Megrahi's case is the bisphosphonate drug Zometa. Given by intravenous infusion, this agent protects the skeleton from the negative effects of prostate cancer cells in the bones. While not increasing overall survival, Zometa has been shown to reduce bone pain, decrease the risk of fractures and improve overall quality of life.

Radiotherapy can also be given to reduce bone pain and reduce symptoms.

The Scottish authorities may regret relying on predictions that Al-Megrahi will be dead within 12 weeks. I would not be at all surprised to read that he is still alive and reasonably active well into 2010, and maybe even beyond.

Professor Roger Kirby MD FRCS is chairman of Prostate UK and director of the Prostate Centre, London

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MacAskill's crime' wasn't to release a murderer but to disobey America

By Paul Lavery

"Why do you see the speck in your brother's eye, but fail to see the beam of wood in your own?"

Matthew Ch7. v 3.

Did anyone else out there feel a tear swell to the surface as the infamous John Bolton, former Bush ambassador to the United Nations, expressed his hurt at Scottish justice minister Kenny MacAskill's decision to free Megrahi? It was all the more disappointing, Bolton explains, because he had a Scottish granny. As the president, secretary of state, joint chief of staff of the armed forces and head of the FBI huffed and puffed about "justice" and the "rule of law" did anyone else feel the contradictory impulse of wanting to convulse in laughter and pound the earth in fury?

What is worthy of reflection in this whole episode is how craven and forelock-tugging our political class and media are in relation to the United States. In vain I have waited to hear a single politician seriously challenge US officials who presume the moral high ground.

John Bolton is a good starting point. In 1997, he said: "There is no such thing as the United Nations. There is only the international community, which can only be led by the only remaining superpower." Bolton was a main architect of the Iraq war. He was an active promoter of the Project for the New American Century, a ruthless blueprint to impose US might around the world to gain unhindered access to natural resources. He was accused of making false statements to the Senate, and was seen, according to one senior Democrat, as a "bull in a china shop" as he bullied and insulted others in the UN.

Have any of these politicians or leader writers, foaming at the mouth at MacAskill, read The Torture Team by top QC Philippe Sands, or kept up to date with detailed research by Human Rights Watch? Sands gives chapter and verse of how torture was once again made official policy by George Bush, Dick Cheney and Robert Rumsfeld, and how senior lawyers made it all possible. Systematic torture spread from the very epicentre of respectable Washington.

All of this was done in the fight against the bad terrorists while the US has financed and trained its own good terrorists at the School of the Americas in Fort Benning, Georgia for decades. Some of its best-known graduates include General Galtieri of Argentina, Rios Montt of Guatemala, Noriega of Panama, and of course Augusto Pinochet, the great friend of Kissinger.

In Nicaragua in the 1980s I met Contra soldiers trained by the CIA and financed by the American taxpayer. One illiterate teenager told me how he finished off survivors from a mine explosion with his knife. I will never forget the horror of two parents who heard their daughter being raped, mutilated, and then murdered by other contras.

While I was there the International Court of Justice condemned the United States for their breach of international law, and in a spectacular snub to that court the US awarded many more millions to the Contras on the same day.

Next time we hear Hilary Clinton tell us who not to release, let's remind her of her own country's collaboration and release of Nazis involved in the Holocaust, especially General Reinhard Gehler, who recruited hundreds of ex-SS members to work with the CIA (including Klaus Barbie, the "Butcher of Lyon") when it suited their narrow self-interest in pursuit of the cold war.

Next time we hear Robert Mueller, head of the FBI, preach about "the mockery of justice" let's remember he lives in a country prepared to execute prisoners for crimes committed in their teenage years (now raised above 18 following a Supreme Court decision in 2005) and where incarceration for many is a barbaric nightmare in privatised prisons.

I suspect MacAskill is castigated not so much for the release a dying man, but because he has refused to obey. US politicians expect their UK and Scottish counterparts to take up automatic poodle positions just as Jack Straw and Tony Blair have always done. True to form, New Labour in Scotland do the same; they seem more concerned with parochial point-scoring or whisky sales in the US than any genuine concern for the understandable feelings of hurt on the part of the families of the victims.

But the great tragedy revealed by this circus is how we have collectively sacrificed our critical faculties, our sense of history, and replaced them with spineless humiliating subservience to the powerful. MacAskill's decision is a brave exception, but it is a disgrace to see him so cornered while the nauseating hypocrisy of the US goes virtually unexamined.

Paul Laverty worked as a human rights lawyer in Central America for more than two years. He wrote the screenplay for The Wind that Shakes the Barley, which won the Palme D'Or in Cannes 2005 and won the Best Screenplay award for Sweet Sixteen in Cannes 2002. Both films were directed by Ken Loach.